Experience with Thoracic Aortic Stent-Grafting at the Royal Brisbane and Women’s Hospital: Outcomes from the First Decade

Abstract

Objectives: To describe thoracic endovascular aortic repair (TEVAR) outcomes at the Royal Brisbane and Women’s Hospital between 2001-2010. Design: Prospective cohort study. Results: We successfully treated 95 of 97 patients for a 98% procedural success rate. Of the treated patients, 68 (72%) were males and mean age was 61 ± 17 years. Average follow up was 3.6 ± 2.0 years. Pathologies treated were: dissection (n = 35), aneurysmal disease (n = 32), traumatic disease (n = 19), coarctation (n = 5) and miscellaneous (n = 4). There was one peri-procedural myocardial infarction. Renal complications occurred in 7 patients (3 with doubling creatinine and 4 requiring temporary renal replacement therapy). Stroke occurred in 2 patients and paresis in 2 patients (permanent in one). Six patients died during index hospitalization and 17 deaths occurred during follow-up, 2 of which were confirmed secondary to aortic pathology. Age (HR 1.08 per year, p < 0.01) and ASA class (HR 2.2 per class, p = 0.02) were independently associated with mortality. There were 25 re-interventions in 22 patients. Eighteen of these re-interventions in 16 patients were related to the management of complications of TEVAR of which 13 were for endoleaks; eight type I, four type II, one type III. Conclusion: TEVAR can be used to treat thoracic aortic pathology but questions remain regarding long-term durability.

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M. Hoenig, J. Jenkins, N. Boyne, A. Kruger and P. Walker, "Experience with Thoracic Aortic Stent-Grafting at the Royal Brisbane and Women’s Hospital: Outcomes from the First Decade," World Journal of Cardiovascular Surgery, Vol. 2 No. 3, 2012, pp. 29-39. doi: 10.4236/wjcs.2012.23009.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] M. D. Dake, et al., “Transluminal Placement of Endovascular Stent-Grafts for the Treatment of Descending Thoracic Aortic Aneurysms,” The New England Journal of Medicine, Vol. 331, No. 26, 1994. pp. 1729-1734. doi:10.1056/NEJM199412293312601
[2] D. Cheng, et al., “Endovascular Aortic Repair versus Open Surgical Repair for Descending Thoracic Aortic Disease: A Systematic Review and Meta-Analysis of Comparative Studies,” Journal of the American College of Cardiology,” Vol. 55, No. 10, 2010, pp. 986-1001. doi:10.1016/j.jacc.2009.11.047
[3] M. A. Coady, et al., “Surgical Management of Descending Thoracic Aortic Disease: Open and Endovascular Approaches—A Scientific Statement from the American Heart Association,” Circulation, Vol. 121, No. 25, 2010, pp. 2780-2804. doi:10.1161/CIR.0b013e3181e4d033
[4] J. S. Coselli, et al., “Results of Contemporary Surgical Treatment of Descending Thoracic Aortic Aneurysms: Experience in 198 Patients,” Annals of Vascular Surgery, Vol. 10, No. 2, 1996, pp. 131-137. doi:10.1007/BF02000756
[5] J. S. Coselli, et al., “Left Heart Bypass during Descending Thoracic Aortic Aneurysm Repair Does Not Reduce the Incidence of Paraplegia,” The Annals of Thoracic Surgery, Vol. 77, No. 4, 2004. pp. 1298-1303. doi:10.1016/j.athoracsur.2003.10.033
[6] K. Minatoya, et al., “Replacement of the Descending Aorta: Recent Outcomes of Open Surgery Performed with Partial Cardiopulmonary Bypass,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 136, No. 2, 2008, pp. 431-435. doi:10.1016/j.jtcvs.2008.03.034
[7] R. K. Greenberg, et al., “Contemporary Analysis of Descending Thoracic and Thoracoabdominal Aneurysm Repair: A Comparison of Endovascular and Open Techniques,” Circulation, Vol. 118, No. 8, 2008, pp. 808-817. doi:10.1161/CIRCULATIONAHA.108.769695
[8] P. Demers, et al., “Midterm Results of Endovascular Repair of Descending Thoracic Aortic Aneurysms with FirstGeneration Stent Grafts,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 127, No. 3, 2004. pp. 664673. doi:10.1016/j.jtcvs.2003.10.047
[9] K. Minatoya, et al., “Replacement of the Descending Aorta: Recent Outcomes of Open Surgery Performed with Partial Cardiopulmonary Bypass,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 136, No. 2, 2008. pp. 431-435. doi:10.1016/j.jtcvs.2008.03.034
[10] T. Suzuki, et al., “Clinical Profiles and Outcomes of Acute Type B Aortic Dissection in the Current Era: Lessons from the International Registry of Aortic Dissection (IRAD),” Circulation, Vol. 108, Suppl. 1, 2003, pp. II312II317. doi:10.1161/01.cir.0000087386.07204.09
[11] M. Kato, et al., “Determining Surgical Indications for Acute Type B Dissection Based on Enlargement of Aortic Diameter during the Chronic Phase,” Circulation, Vol. 92, Suppl. 9, 1995, pp. 107-112. doi:10.1161/01.CIR.92.9.107
[12] M. D. Dake, et al., “Endovascular Stent-Graft Placement for the Treatment of Acute Aortic Dissection,” The New English Journal of Medicine, Vol. 340, No. 20, 1999, pp. 1546-1552. doi:10.1056/NEJM199905203402004
[13] C. A. Nienaber, et al., “Nonsurgical Reconstruction of Thoracic Aortic Dissection by Stent-Graft Placement,” The New English Journal of Medicine, Vol. 340, No. 20, 1999, pp. 1539-1545. doi:10.1056/NEJM199905203402003
[14] C. A. Nienaber, et al., “Randomized Comparison of Strategies for Type B Aortic Dissection: The INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) Trial,” Circulation, Vol. 120, No. 25, 2009, pp. 2519-2528. doi:10.1161/CIRCULATIONAHA.109.886408
[15] L. F. Parmley, et al., “Nonpenetrating Traumatic Injury of the Aorta,” Circulation, Vol. 17, No. 6, 1958, pp. 10861101. doi:10.1161/01.CIR.17.6.1086
[16] U. O. Von Oppell, et al., “Traumatic Aortic Rupture: Twenty-Year Metaanalysis of Mortality and Risk of Paraplegia,” The Annals of Thoracic Surgery, Vol. 58, No. 2, 1994, pp. 585-593. doi:10.1016/0003-4975(94)92270-5
[17] F. H. W. Jonker, et al., “Trends and Outcomes of Endovascular and Open Treatment for Traumatic Thoracic Aortic Injury,” Journal of Vascular Surgery, Vol. 51, No. 3, 2010, pp. 565-571. doi:10.1016/j.jvs.2009.10.046
[18] G. P. Clagett, “EVAR, TEVAR, FEVAR, Too Far?” Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 20, No. 2, 2008, pp. 115-119. doi:10.1177/1531003508319379
[19] V. L. Gott, et al., “Replacement of the Aortic Root in Patients with Marfan’s Syndrome,” The New England Journal of Medicine, Vol. 340, No. 17, 1999, pp. 13071313. doi:10.1056/NEJM199904293401702
[20] H. Ince, et al., “Stent-Grafts in Patients with Marfan Syndrome,” Journal of Endovascular Therapy, Vol. 12, No. 1, 2005, pp. 82-88. doi:10.1583/04-1415MR.1
[21] I. M. Nordon, et al., “Endovascular Management of Chronic Aortic Dissection in Patients with Marfan Syndrome,” Journal of Vascular Surgery, Vol. 50, No. 5, 2009, pp. 987-991. doi:10.1016/j.jvs.2009.05.056
[22] R. P. Cambria, et al., “A Multicenter Clinical Trial of Endovascular Stent Graft Repair of Acute Catastrophes of the Descending Thoracic Aorta,” Journal of Vascular Surgery, Vol. 50, No. 6, 2009, pp. 1255-1264, e1-e4.
[23] F. H. W. Jonker, et al., “Outcomes of Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysms,” Circulation, Vol. 121, No. 25, 2010, pp. 2718-2723. doi:10.1161/CIRCULATIONAHA.109.908871
[24] F. H. Jonker, et al., “Meta-Analysis of Open versus Endovascular Repair for Ruptured Descending Thoracic Aortic Aneurysm,” Journal of Vascular Surgery, Vol. 51, No. 4, 2010, pp. 1026-1032, 1032 e1-1032 e2.

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